Interoperable clinical document-exchange system

ABSTRACT

A method of exchanging messages between users over a network includes receiving a registration request from an organization and provisioning an organizational sub-domain, verifying the registration request according to requirements of a first protocol and provisioning a first user address that is part of the organizational sub-domain, and sending a message from the first user address to a second user address according to the first protocol.

FIELD OF THE INVENTION

This invention relates generally to the field of digital security andelectronic communications, and more particularly to computerized systemsand methods for interoperable clinical document-exchange.

BACKGROUND

Multiple files, records, and documents are created for individualpatients every day. This widely varying collection of documents and datacomes from many different care organizations, each of which may usedifferent systems for storing, managing, and sending information. Toensure quality care for patients who may require services from more thanone organization, each organization may need access to the documents anddata produced and stored by another organization.

Organizations have frequently relied on decades-old unsecure faxtechnology or ordinary paper mail to exchange these documents and data.With the advent of the internet, many care organizations exchangeclinical documents online, using equally unsecure technologies, such asemail. This practice threatens the confidentiality of patientinformation and serves as an inefficient means for exchanging clinicaldocuments and data.

As patient and legislative awareness of the importance of patientprivacy has increased, however, so has the need for a way to exchangeclinical documents securely, conveniently, and in an interoperablemanner. Governments and standard-setting-organizations have begun toadopt protocols for exchanging clinical documents, but there is nouniversal standard. A single, global standard for document-exchange maynever emerge given the varying requirements for patient privacy amongjurisdictions, organizations, and countries. As a result, the exchangeof clinical documents remains inconvenient, fragmented, and unsecure.

SUMMARY OF THE INVENTION

Computer implemented systems, methods, and computer-readable mediaconsistent with the invention for exchanging data between users over anetwork may exchange messages, documents, and other data.

A cloud-based computer-implemented method, consistent with the inventionfor exchanging data between users over a network, comprises receiving aregistration request from an organization and provisioning anorganizational sub-domain, verifying the registration request accordingto requirements of a first protocol, and provisioning a first useraddress to a first user, wherein the first user address is part of theorganizational sub-domain and sending a message from the first useraddress to a second user address according to the first protocol.

A computer-implemented system for exchanging data between users over anetwork consistent with this invention comprises a storage device thatstores instructions and a processor configured with the instructions (i)to receive a registration request from an organization and provision anorganizational sub-domain, (ii) to verify the registration requestaccording to requirements of a first protocol, and provision a firstuser address to a first user, wherein the first user address is part ofthe organizational sub-domain, and (iii) to send a message from thefirst user address to a second user address according to the firstprotocol.

BRIEF DESCRIPTION OF DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this disclosure, illustrate several embodiments and aspects ofthis disclosure, and together with the description, serve to explaincertain principles of the invention.

FIG. 1 illustrates an exemplary system environment for implementing theembodiments in this disclosure.

FIG. 2 illustrates an exemplary system for implementing embodiments ofthis invention.

FIG. 3 illustrates an exemplary organizational structure consistent withembodiments of this invention.

FIG. 4 illustrates a flowchart of an exemplary messaging processconsistent with this invention.

FIG. 5 illustrates an exemplary graphical user interface (GUI) for adocument-exchange application consistent with this invention.

FIG. 6 illustrates an exemplary system for implementing this invention.

DETAILED DESCRIPTION

The embodiments of FIGS. 1-6 are provided for purposes of illustration,and not limitation.

Embodiments of this disclosure encompass systems, methods, andcomputer-readable media, for exchanging data between users over anetwork. By way of example, data may be exchanged in a clinical contextbetween organizations that provide medical care for patients. Data mayinclude messages, notes, images, clinical documents, and any other datarelevant to patient care.

Data exchange may occur according to one or more protocols to ensureprotection of patient privacy. As used in this disclosure, “protocol”refers to a standard or set of standards, such as the standardspromulgated by the Direct Project. A protocol may include requirementsfor identity verification, such as compliance with one of the IDproofing levels promulgated by the National Institute of Standards andTechnology (NIST). A protocol may further include a standard or set ofstandards for secure communication. For example, a protocol may requireasymmetric cryptography and/or registration with a central databaseauthority, or a certain level of security from point to point, e.g.,from message sender to message receiver, interoperable data exchange maybe achieved allowing data to be exchanged among organizations and usersemploying differing protocols.

Embodiments of this invention encompass systems, methods, andcomputer-readable media, for exchanging clinical information betweenusers of organizations over a network. Clinical data may be exchangedbetween users of different organizations providing medical care to oneor more patients, in a one-way or bi-directional manner, and accordingto one or more protocols. The protocol may require user- ororganization-level verification according to one or more protocols toensure patient privacy or to comply with legislative mandates.

FIG. 1 illustrates an exemplary system environment 100, while theexemplary embodiment of FIG. 1 and the other embodiments described referto clinical document-exchange, embodiments consistent with the inventionmay handle other forms of electronic communications, such as insurancedocuments or legal communications. The arrangement and number ofcomponents in FIG. 1 is only exemplary, and different numbers andarrangements and components are also possible.

System environment 100 may include document-exchange system 110, network120, a plurality of organizations 130 and 140, and a plurality of users131, 132, 133, 141, 142, 143, and 151. Document-exchange system 110 mayinclude components of the system described further below in reference toFIG. 2. Organizations 130 and 140 may be organizations that interactwith document-exchange system 110, such as hospitals, clinics, or othercare organizations, that seek to exchange data with each other. Eachorganization may have users that are part of the organization. Forexample, users 131, 132, and 133 are pad of organization 130. Users maybe employees (e.g., doctors or receptionists) in their respectiveorganization. The organizations may interact with document-exchangesystem 110 through their users.

Document-exchange system 110 may receive registration requests fromorganizations or users. A registration request may include anycombination of data, a message, or a signal that indicates theorganization or user is seeking to register with document-exchangesystem 110. For example, document-exchange system 110 may receive apredefined message in the form of a data packet that indicates anorganization is requesting registration.

Document-exchange system 110 may receive registration requests throughnetwork 120. Network 120 may comprise one or more networks suitable forelectronic communication, such as the internet, an intranet, or a localLAN. Network 120 can also include virtual networks. For example,organizations and users may connect to network 120 and send virtualrequests to document-exchange system 110 that never leave a mainframe orare routed via a virtual private network to document-exchange system110.

As a result of receiving a registration request from an organization,document-exchange system 110 may provision a sub-domain for theorganization. A “sub-domain,” as used in this disclosure, may be avirtual representation that corresponds to an organization or group. Asub-domain may comprise a domain that is part of a larger domain. Thedomains and sub-domains may have a tree structure or hierarchy, witheach sub-domain, other than the root domain, having a parent domain andeach parent domain having a child sub-domain. The only domain that isnot also a subdomain may be called the root domain, for example,document-exchange system 110 may provision a sub-domain based on theDomain Name System (DNS) naming system for computers, services, andresources that are connected to the internet or a private network. Adocument-exchange system 110 may include a root domain, e.g.,docexchange.org, and provision a sub-domain as a result of receiving aregistration request, e.g., subdomain.docexchange.org.

To further illustrate, as a result of receiving a registration requestfrom organization 130, document-exchange system 110 may provision asub-domain corresponding to organization 130 (e.g.,organization130@docexchange.org). The sub-domain corresponding toorganization 130 may be part of a larger domain corresponding to thedocument-exchange system. The subdomain corresponding to theorganization 130 may be part of a larger domain corresponding to thetype of organization. For instance, organization 130 may be a hospital.As a result of receiving a registration request, document-exchangesystem 110 may provision a sub-domain to organization 130 that is partof a larger domain corresponding to hospitals (e.g.,organization130.hospitals.docexohange.org). The larger domain may itselfbe a sub-domain that is part of a larger domain. In the previousexample, the larger domain corresponding to hospitals was part of astill larger domain corresponding to document-exchange system 110.

Other implementations of tree structures and domains are contemplated bythis disclosure, and reference to the DNS naming system is by way ofexample only. For instance, document-exchange system 110 may provisionsub-domains in the form of folders in a hierarchical folder structure,e.g., docexchange.org/organization130. Document-exchange system 110 mayalso provision a sub-domain that does not manifest itself to theorganizations or users in any way. For example, document-exchange system110 may provide access to an organization and its users to theirsub-domain through a dedicated page that does not reflect itsrelationship with its parent sub-domain or any other sub-domain ordomain.

Document-exchange system 110 may verify the registration requestaccording to the requirements of a protocol. A protocol may include astandard or set of standards for verification of a registration request.Embodiments for verifying the registration request are described furtherbelow in reference to FIG. 2.

Document-exchange system 110 may provision user addresses to users.Document-exchange system 110 may provision user addresses to users in arequesting organization. For example, document-exchange system 110 mayprovision a user address to users 131, 132, and 133 after provisioning asub-domain corresponding to organization 130 and verifying theorganization's registration request. User addresses may be part of theorganization's sub-domain. For example, document-exchange system 110 mayprovision a user address to user 131 that is part of the sub-domain oforganization 130 (e.g.,user131@organization130.documentexchangesystem.org).

Document-exchange system 110 may provision user addresses that are notpart of an organization's sub domain. For example, document-exchangesystem 110 may provision a user address to user 151, who is not part ofor employed by an organization. Document-exchange system 110 mayprovision such user addresses as standalone user addresses. For example,document-exchange system 110 may provision such user addresses asstandalone user addresses and provide access through a separate pagethat is not associated with an organization. Document-exchange system110 may also provision user addresses that are part of a sub-domain thatis not associated with an organization. For example, document-exchangesystem 110 may provision a user address that is part of a sub-domainassociated with solo practitioners to user 151, who may be a solopractitioner. In another example, document-exchange system 110 mayprovision a user address that is part of a sub-domain associated withpatients to user 151, who may be a patient.

Document-exchange system 110 may also receive messages from theorganizations or users through network 120. Such messages may includedocuments, messages, or other data that one organization or user desiresto transmit to another organization or user. For example,document-exchange system 110 may receive a message from organization 130in the form of a patient chart. The message may also include a recipientaddress indicating the desired destination for the message. Forinstance, document-exchange system 110 may receive a message fromorganization 130 that includes a recipient address for user 141 inorganization 140. As a result, document-exchange system 110 may send themessage from organization 130 to user 141.

Document-exchange system 110 may send and receive messages throughnetwork 120 according to a protocol. Document-exchange system 110 mayalso send and receive messages according to a secure protocol. Forexample, document-exchange system 110 may send messages in the form ofencrypted data streams as required by the protocol. Document-exchangesystem 110 may send the message in the form of an encrypted email.Document-exchange system 110 sends and receives messages according tothe DirectTrust framework standards. For example, document exchangesystem 110 may employ asymmetric cryptography, also known as public-keycryptography, to encrypt messages using the recipient's public key. As aresult, the recipient may decrypt the message using the recipient'sprivate key. Document-exchange system 110 may also send and receivemessages according to other protocols. For example, document-exchangesystem 110 may send and receive messages according to the NationalHealth information Network Exchange protocol. The protocols providedhere are by way of example only and not limiting.

Document-exchange system 110 may send and receive messages bysimultaneously using these protocols and other protocols to achieveinteroperable exchange of clinical documents and data. For example,document exchange system 110 may use different protocols for sending andreceiving messages. Document-exchange system 110 may send and receivemultiple messages through network 120 according to more than oneprotocol. To illustrate, document-exchange system 110 may send a messagefrom user 131 to user 141 according to a protocol that requiresend-to-end secured communications. For example, document-exchange system110 may receive a message, intended for user 141, from user 131 that issecured through Transport Layer Security (TLS) or its predecessor,Secure Sockets Layer (SSL). This may occur, for instance, when user 131accesses the sub-domain of organization 130 through a web portalprovided by document-exchange system 110. Document-exchange system 110may then send that message to user 141 using a secure form ofcommunication, e.g., asymmetric cryptography. For example,document-exchange system 110 may send the message by encrypting it withuser 141's public key and send the result to user 141. User 141 may thenaccess the message by decrypting the received data using the associatedprivate key. Document-exchange system 110 may then send a message fromuser 132 to user 141 according to another protocol that also requiresend-to-end encryption, but requires the use of symmetric keycryptography. Document-exchange system 110 may then receive a secondmessage intended for user 141, from user 132 that is secured throughSSL/TLS. Document-exchange system 110 may then send the second messageto 141 according to the second protocol, using symmetric keycryptography.

In another example, document-exchange system 110 may send the samemessage from a single user to multiple users according to one or moreprotocols. To illustrate, document-exchange system may send a messagefrom user 131 to user 141 to a first protocol and another message fromuser 131 to user 142 according to a second protocol. Document-exchangesystem 110 may use a wide variety of protocols to achieve interoperabledocument exchange.

Document-exchange system 110 may send messages directly or indirectly tousers. Document-exchange system 110 may send messages directly to users.For example, document-exchange system 110 may send a message directly touser 141's device encrypted using user 141's public key. User 141 maythen access the encrypted message by using the associated private key.Document-exchange system 110 may also send messages indirectly to users.For example, document-exchange system 110 may determine thatorganization 140, of which user 141 is a part, is associated withanother document-exchange system. Document-exchange system 110 mayfurther determine that the second document-exchange system is theappropriate intermediate recipient of messages to user 141. For example,document-exchange system 110 may determine that the seconddocument-exchange system handles user 141's private keys on behalf ofuser 141. Accordingly, document-exchange system 110 may send the messageto user 141 indirectly by sending it to the second document-exchangeserver. User 141 may then access the message by receiving it from thesecond document-exchange system. For example, user 141 may access a webportal of the second document-exchange system and access the message.The verbs “send” and “receive” encompass both direct and indirecttransmission of messages.

FIG. 2 illustrates exemplary system 200 for implementing embodimentsconsistent with this invention. System 200 includes document-exchangesystem 201, and document-exchange system 201 includes request receiver210, database 220, verifier 230, web portal 240, message receiver 250,and message sender 260. These components of system 200 may beimplemented using any suitable combination of hardware, software, and/orfirmware. The components may correspond to functional blocks implementedwith a set of instructions executed by suitable hardware (e.g., acomputer, a server, a group of computers, or one or more computing nodesoperating over a network). The components may also correspond toprogrammable, fixed-function hardware, such as programmable-logicdevices, such as PALs, PLAs, CPLDs, or FPGA. The number and arrangementof components in FIG. 2 is merely provided for illustration.

Request receiver 210 may receive registration requests, which mayoriginate from organizations. For example, organization 130 may send arequest indicating a desire to join and other messages throughdocument-exchange system 201. Organization 130 may be a hospital,clinic, or other care organization wishing to exchange clinical data.Registration requests may also originate from users. For example, user131 may send a request indicating a desire to join and send messagesthrough document-exchange system 110. Registration requests originatingfrom users may indicate their association with one or moreorganizations. For example, user 131 may indicate in or with the requestan association with organization 130. User 131 may be, a physician ornurse in the hospital or other care organization. Registration requestsoriginating from users may also indicate no organizational association.For instance, user 151 may send a registration request. User 151 may bea solo practitioner or a patient that lacks organizational affiliation.Users that are part of an organization may decline to indicate anorganizational association. For example, user 132 may send aregistration request and decline to indicate an organizationalassociation.

Request receiver 210 may access database 220. Request receiver 210 mayaccess database 220 to determine whether the requesting user ororganization already has access to document-exchange system 201. Forexample, request receiver 210 may compare information with theregistration request with information in database 220 to determinewhether the registering organization or user has already beenprovisioned a subdomain or address respectively. Request receiver 210may then deny the request and send a signal to the requestingorganization or user to indicate the previous registration. Requestreceiver 210 may access database 220 and determine the requestingorganization or user does not have access to document-exchange system201. Request receiver 210 may then send the registration request alongwith any supplied data to verifier 230.

Database 220 may store data used by document-exchange system 201.Database 220 may store user and organizational information, such as toindicate an organization has previously registered withdocument-exchange system 201 or has previously been provisioned asub-domain. Database 220 may also store information to indicate a userhas previously registered with the document-exchange system or haspreviously been provisioned a user address. Database 220 may also storedata describing the relationship between users and organizations. Forexample, database 220 may store information indicating a user is amember of an organization. Database 220 may also store informationindicating whether the user was formerly a member and the period of timeduring which the user was a member. Embodiments for storing therelationship between users and organizations are described further belowin reference to FIG. 3.

Database 220 may store other information associated with the operationof document-exchange system 201. For example, database 220 may storedata associated the organizational sub-domains or message templates fromdocument-exchange system 201, as described further below in reference toFIG. 5. In still another example, database 220 may store informationrelating to the document-exchange capabilities of organizations andusers in geographic areas. For example, database 220 may storeinformation describing the location of each user and organization, andallow users to choose a protocol for sending a message as describedfurther below in reference to FIG. 5.

Database 220 may also store keys, such as public and private keysassociated with document-exchange system 201. For example, database 220may store public and private keys associated with document-exchangesystem 201 so messages from document-exchange system 201 may be signedwith a digital certificate and messages received may be decrypted.Database 220 may store keys associated with other document-exchangesystems or trust authorities. For example, database 220 may store thepublic key of a trust authority or other document-exchange system toallow document-exchange system 201 to send and receive messages securelyto users through intermediaries.

Database 220 could store keys associated with users and organizations,such as public and private keys associated with users. A user may send amessage to document-exchange system 201 through web portal 240, asdescribed further below, that is secured through SSL/TLS.Document-exchange system 201 may then send the message to the recipientby encrypting the message with the user's private key.

Database 220 may store any information related to the operation ofdocument-exchange system 201 and the foregoing examples are provided byway of example and are by no means exhaustive.

Verifier 230 may verify registration requests from both users andorganizations. Verifier 230 may verify the registration requestaccording to requirements of a protocol, such as the NIST Level 3 ofAssurance for identity proofing as specified in NIST SP 800-63-1.Verifier 230 may verify the registration request from the organizationby verifying the identity of the requesting representative of theorganization and the organization's name and address. Verifier 230 mayalso verify the identity of the requesting representative by confirminginformation in the form of a government-issued ID number andfinancial-account number with the applicable agency or a credit bureaudatabase. Verifier 230 may also verify the organization's name, address,and existence through a database. For example, Verifier 230 may verifyan organization's name and address through a public database, such asEDGAR, or through a credit bureau.

Verifier 230 may also verify the registration request according to otherrequirements. For example, verifier 230 may verify a registrationrequest from an organization by complying with internal protocols set bythe provider of document-exchange system 201 as company policy, pursuantcontractual obligations, or for other reasons. For example, verifier 230may forgo verifying a registration request from a user after determiningthe organization included the user on an authorized user list and signeda waiver waiving verification or a certification certifying the users onthe authorized user list have been independently verified.

Verifier 230 may examine data in database 220, for example to verify theregistration request received by request receiver 210. For example,verifier 230 may examine data stored in database 220 to determinewhether the organization has previously attempted registration. Verifier230 may vary or increase the requirements for successful verificationbased on the number of previous, unsuccessful registration attempts orother factors. For example, verifier 230 may vary the requirements forsuccessful verification based on the requirements of a protocol thatcalls for “trust” verification with a central database.

Verifier 230 may also examine organizational data in database 220. Forexample, database 220 may store organizational information as anauthorized employee list, as further described below in reference to webportal 240. Verifier 230 may vary, decrease, or eliminate altogether,the requirements for successful verification of a user based on thepresence of that user in an authorized list. In another example,database 220 may store organization information indicating that theorganization has signed a release or certification that affirms theidentity of individuals in a list. Verifier 230 may then vary, decrease,or eliminate altogether, the requirements for successful verification ofa particular user based on the presence of that user in the list.

Verifier 230 may also store data in database 220, such as theverification results of each registration request. For example, verifier230 may store information in database 220 indicating that a verificationrequest has been received and the results of the verification byverifier 230. Verifier 230 may also communicate verification resultswith web portal 240. For example, verifier 230 may communicatesuccessful verification of a registration request to web portal 240 bysetting a flag in database 220 or through another method.

Web portal 240 may provision organizational sub-domains toorganizations. Web portal 240 may only provision an organizationalsub-domain after verifier 230 has successfully verified a registrationrequest from an organization.

Web portal 240 may store an organizational sub-domain in database 220.Web portal 240 could create a virtual representation of an organizationin the form of a sub-domain that is pad of a larger domain and store therepresentation in database 220. For example, web portal 240 may create adirectory structure corresponding to the organizational sub-domain indatabase 220.

Web portal 240 may allow access to the organizational sub-domain throughan interface, such as a web page located at a particular uniformresource indicator (URI) or at a uniform resource locator (URL) thatcompiles with the DNS naming system called“organization130.hospitals.docexchange.org.” Web portal 240 may alsoallow access to an organizational sub-domain through another interface,such as a dedicated software platform. For example, web portal 240 mayinteract with a dedicated software platform used by the organization andprovide access to the sub-domain through that platform.

Web portal 240 may allow an organization's representative to interactwith its sub-domain. Web portal 240 could provide the organization witha login to access the organization's sub-domain. For example, web portal240 may provide a login that allows a representative of the organizationto add and remove authorized users to the organization's sub-domain. Webportal 240 may also allow an organization's representative to interactwith its sub-domain through other means. For example, web portal 240 maydetect the computer from which a representative attempts to access thesub-domain through its IP address and save information about thecomputer to database 220. Web portal 240 may use or combine othersecurity measures, such as requiring a signed digital certificate beforeallowing an organization's representative to interact with thesub-domain.

Web portal 240 may allow an organization's representative to enterinformation about the organization and its users. Web portal 240 mayalso allow an organization to enter information sufficient to describean organizational structure. Such information may include (i)information relating to the hierarchical structure of the organization,such as its subdivision into departments, (ii) information relating tothe physical location of individuals in the organization, such asgeographic location, or physical location in a building or floor, or(ii) relational information in a conceptual subgroup. Embodiments oforganizational information that may be stored in database 220 aredescribed further below in reference to FIG. 3.

Web portal 240 may allow an organization to add or remove users, forexample, by allowing an organization's representative to specify a listof authorized users. For example, an organization's representative mayspecify a list of employees of the organization that require access todocument-exchange system 201. As a result, web portal 240 may store theauthorized employee list as organizational information in database 220.Web portal 240 may also prohibit an organization from adding or removingusers, or may only allow an organization to remove users, such as, whenan employee leaves an organization. In this example, web portal 240 mayrequire that a user initiate a registration request and completeverification by verifier 230 to add a user. Web portal 240 may alsoprohibit an organization from removing users and instead require usersto request their removal.

Web portal 240 may allow users to initiate registration requests. Webportal 240 could allow organizational employees to initiate registrationrequests. For example, web portal 240 may provide an interface to allowa user to request access to a particular organizational sub-domain byspecifying the organization for which the user works. Web portal 240 mayinvite users to initiate registration requests. For example, web portal240 may invite the users in an authorized employee list to submitregistration requests. Web portal 240 may also allow users withoutorganizational affiliations to initiate registration requests. Forexample, web portal 240 may allow a solo practitioner or a patient tosubmit a registration request.

Web portal 240 may send registration requests from users to verifier230. Web portal 240 may send the registration request to verifier 230and add the user to the organizational sub-domain after verifier 230verifies the registration request. For example, web portal 240 may senda registration request from a doctor at the organization to verifier230. After verifier 230 verifies the registration request, web portal240 may provision a user address to the doctor.

Web portal 240 may also provision user addresses to members or employeesof an organization. For example, web portal 240 may provision a useraddress to a doctor at an organization as a result of a successfulregistration request or may provision user addresses to those withoutany affiliation to an organization, such as a patient or solopractitioner that is not part of an organization. Web portal 240 mayalso provision a user address automatically without a registrationrequest from the user. For example, an organization, through itsrepresentative, may enter a list of authorized users into web portal 240and indicate it has signed a release or the users have beenindependently verified by the organization. As a result, web portal 240may provision a user address to each of the users in the authorizedlist.

Web portal 240 may also provision user addresses that are part of anorganizational sub-domain. Web portal 240 may also provision useraddresses according to a protocol, such as the Direct standardspromulgated by the Direct Project organization. The provider ofdocument-exchange system 201 may partner with a health informationservice provider (HISP) to provide user addresses in the form of Directaddresses. As a result, web portal 220 may provision a user address thatis part of an organization sub-domain in the form of a Direct address,such as user@organization.documentexchange.org. The provider ofdocument-exchange system 201 may itself be a HISP and provide Directaddresses, such as user@organization.HISP.org.

Web portal 240 may also provision user addresses according to anotherprotocol. For example, web portal 240 may provision user addressesaccording to a protocol mandated by law. Provisioning user addresses maycomply with many protocols, including those not mentioned in thespecification.

Web portal 240 may also provision addresses to comply with multipleprotocols. For example, web portal 240 may provision a single useraddress, e.g., user@organization.documentexchange.org, that complieswith both the DirectTrust and Western States Consortium PilotImplementations of the Direct standard, or provision a single useraddress that complies with the Direct standard and another protocolaltogether.

Web portal 240 may also provision one or more back-end addressesassociated with a user address to comply with conflicting protocols. Forexample, two protocols may require features that inherently conflictwith each other. Web portal 240 may, in such a case, provision one ormore back-end address for each of these conflicting protocols. Webportal 240 may provision back-end addresses that are transparent to theuser. For example, web portal 240 may provision a user address to theuser called user@organization.com and two back-end addresses calleduser@organlzation.HISP.org and protocol3762/org\user. Web portal 240 mayalso provision a single back-end address that is the same as the useraddress, or may provision multiple back-end addresses, one of whichserves as the user address. Web portal 240 may provision one or moreback-end addresses to enable users to send messages through a singleuser address according to multiple protocols, each of which may beassociated with a back-end address.

Web portal 240 may interact with message receiver 250 and message sender260 to allow users and organizations to send and receive messages toother organizations and their users. For example, web portal 240 mayallow a doctor to send a patient file to another doctor who works at aneighboring hospital or to other users in the same organization. Forexample, web portal 240 may allow a nurse to send a message to theattending physician in the same hospital.

Web portal 240 may interact with a graphical user interface (GUI). Webportal may provide a GUI directly, such as a web page at a URL, wherethe web page allows users and organizations to send and receive messagesthrough document-exchange system 201. Web portal 240 may also notprovide a GUI directly, such as by interacting through a network with aGUI provided by another system like a standalone application on a user'ssystem.

Web portal 240 may interact with a GUI according to a protocol, such asby interacting securely with the GUI according to a protocol likeSSL/TTS. Web portal 240 may also secure communications as a result of aprotocol that requires end to end encryption between the sender andrecipient of messages exchanged according to the protocol.

Web portal 240 may interact with a GUI to allow users and organizationsto send and receive messages through document-exchange system 201. Anexample of a GUI for a messaging application consistent with thisinvention is described in further detail with reference to FIG. 5 below.

Message receiver 250 and message sender 260 receive and send messagesrespectively. They may receive and send messages according to aprotocol. For example, message receiver 250 and message sender 260 mayreceive and send messages according to a secure protocol, such as theDirect standard or according to multiple protocols. For example, messagereceiver 250 and message sender 260 may receive and exchange messageswith one user using one protocol and with another user using a differentprotocol.

The protocol message receiver 250 and message sender 260 use may havecertain requirements, such as a certain level of encryption. Forexample, the protocol may mandate encryption using symmetric keyencryption with a key of a particular length. The protocol may haveother message requirements. For instance, the protocol may mandate aparticular message syntax, message length, document structure, or otherfeature. The protocol may have requirements unrelated to the messageitself. For example, the protocol may require registration of addressesin a central database authority and allow messaging only betweenregistered addresses, or distribution of public keys with particularentitles. The protocol may also only allow sending messages throughpredefined, approved intermediaries.

Message receiver 250 and message sender 260 may exchange messages withusers or organizations. Message receiver 250 and message sender 260 maysend and receive messages from/to users and/or organizations that areregistered with document-exchange system 201. For example, messagereceiver 250 and message sender 260 may exchange messages with employeesin a hospital that has registered with document-exchange system 201 andhas been provisioned a sub-domain.

Message receiver 250 may also receive messages from users ororganizations that have not registered with document-exchange system201. For example, message receiver 250 may receive from a user notregistered with document-exchange system 201 a message intended for aregistered recipient. Message sender 260 may send messages from aregistered user to another user that is unregistered. For example, adoctor employed by a registered organization may desire to send amessage to another doctor employed by an unregistered organization.

Message sender 260 may send messages directly or indirectly. Messagesender 260 sends messages directly to an address associated with therecipient, such as directly to the Direct address of a recipient thatcomplies with the Direct standard. Message sender 260 may also sendmessages indirectly through an intermediary, such as to anotherdocument-exchange system or an HISP that forwards the message to therecipient or another intermediary.

Message receiver 250 and message sender 260 may interact with database220. They may interact with public and private keys in database 220. Inthis way, they can implement symmetric-key or other encryptionalgorithms.

Message receiver 250 may receive messages through multiple protocols.For example, message receiver 250 may receive a message from doctor B oforganization 2 according to one protocol and receive a message fromnurse C of organization 3 according to a second protocol. Messagereceiver 250 can also receive messages according to different protocolsusing different back-end addresses for each protocol. For example,message receiver 250 may receive a first message using a first back-endaddress according to a first protocol and receive a second message usinga second back-end address according to a second protocol.

Message sender 260 may send messages according to one or more protocols.For example, message sender 260 may send a message from doctor A oforganization 1 to doctor B of organization 2 according to one protocol,and send a message to nurse C of organization 3 according to a secondprotocol. Message sender 260 may send messages according to differentprotocols using different back-end addresses for each protocol.

Message sender 260 may determine which back-end address to use based onthe capabilities of the recipient. For example, message sender 260 maydetermine to use one protocol and back-end address to send a message toa particular recipient that cannot receive messages according to adifferent protocol. Message sender 260 may interact with web portal 240to provide the sending user with an indication of the receivingcapabilities of the user. Message sender 260 may interact with webportal 240 to provide the user with a list of protocols the recipientcomplies with, or may indicate to the sending user which users complywith which protocols. FIG. 5 below, shows this in more detail. Messagesender 260 may also not provide an indication of the protocol used tothe sender, which may be the case if the protocol used by message sender260 were visible or transparent to the user, as described further belowin reference to FIG. 5.

FIG. 3 illustrates an exemplary organizational structure. Organizationalstructure 300 is provided by way of illustration and example only, andthat this disclosure contemplates other organizational structures. Forexample, an organizational structure could be in the form of amulti-root tree or in list form. Organizational structure 300 mayrepresent the structure of organization 310 in the form of a tree withnodes. Organization 310 may include nodes defining subgroups.Organization 310 may also include departments. For example, organization310 is a hospital and includes reception 320, emergency 330, discharge340, and surgery 350. Each department may include users (e.g.,employees) that work m the department. Reception 320 includes users 321and 322.

Organizational structure 300 may represent the employment relationshipsof employees in an organization. It may include user 331 in emergencydepartment 330. Organizational structure 300 may also represent thephysical location of employees in an organization, such as showing thatuser 321 physically sits at a reception area, represented here by node320. Organizational structure 300 may also represent the location ofindividuals at different offices. Organizational structure 300 may bestored as a file or collection of files in database 220.

Organizational structure 300 may be provided by an organization.Organizational structure 300 may be provided by an organization throughweb portal 240. For example, web portal 240 may interact with a GUI toprovide an interface for inputting a list of employees and departmentsfor which the employees work. Organizational structure 300 can beprovided by users through web portal 240. For example, web portal 240may interact with a GUI to provide an interface for each user to inputtheir location and department upon registration.

Organizational structure 300 may be used by users sending messagesthrough document-exchange system 201. Users may use organizationalstructure 300 to select message recipients, such as to determine theappropriate user address. Users may also use organizational structure300 to enhance their efficiency and optimize their workflow. Forexample, web portal 240 may use organizational structure 300 to selectmessage templates automatically or select user addresses as describedfurther below in reference to FIG. 5. Organizational structure 300 maybe displayed to users using any suitable GUI, such as a list with tagsor as collapsible tree structure.

FIG. 4 illustrates a flowchart of an exemplary messaging process,consistent with this invention. Process 400 may be implemented with oneor more of the components in FIG. 2, but other arrangements andimplementations are possible. Process 400 may be implemented with one ormore processors. The order of the steps in FIG. 4 is merely exemplary.

In step 402, request receiver 210 receives a registration request thatmay come from an organization. The registration request may indicate adesire of the organization to access document-exchange system 201.Request receiver 210 may access data stored in database 220. Requestreceiver 210 may also update data in database 220 and forwardinformation with the registration request to verifier 230.

In step 403, verifier 230 verifies the registration request, such asaccording to requirements of a protocol. Verifier 230 may examine andupdate data stored in database 220.

In step 404, document-exchange system 201 determines whether verifier230 successfully verified the registration request. If not, the processproceeds to step 405 and terminates. If verifier 230 successfullyverified the registration request, the process proceeds to step 406.

In step 406, web portal 240 may provision an organizational sub-domain.Web portal 240 may update database 220 to reflect the provisionedorganizational sub-domain. Web portal 240 may interact with a GUI toallow an organization's representative to interact with the sub-domainto input an authorized user list.

In step 407, web portal 240 may provision user addresses, such as inresponse to registration requests from users. Web portal 240 may alsoforward information in a user registration request to verifier 230. Webportal 240 may interact with database 220 to store and retrieve data inconnection with provisioning user addresses. Web portal 240 may alsoprovision user addresses as a result of an organization's representativeadding users to an authorized user list.

In step 408, message receiver 250 and message sender 260 receive andsend messages from and to the provisioned user address. Message receiver250 and message sender 260 may receive and send messages from and to theuser address through back-end addresses, and may interact with a GUI, toallow users to receive and send messages from and to the provisioneduser address. Message receiver 250 and message sender 260 may receiveand send messages that comply with one or more protocols, to achieveinteroperable messaging.

FIG. 5 illustrates an exemplary GUI for a document-exchange applicationconsistent with the invention. Document-exchange application 500 mayinclude recipient field 510, from field 520, address book 515, templateselector 530, message area 540, and send button 590. The number andarrangement of components and features in FIG. 5 may vary and areprovided by way of illustration only. A different GUI may be appropriatefor a document-exchange application provided through a website interfacethan through a standalone or dedicated application. Different GUIs mayalso be appropriate for different platforms, such as a phone, tablet, orPC.

Document-exchange application 500 may interact with web portal 240 asdescribed above with reference to FIG. 2, such as to allow users to sendand receive messages through document-exchange system 201.Document-exchange application 500 and web portal 240 can exchange data,such as through web portal 240. For example, document-exchangeapplication 500 may receive a recipient list from web portal 240 indatabase 220, as described below in reference to address book 515.Communications between document-exchange application 500 and web portal240 may follow a protocol, such as one that requires securedcommunications through SSL/TTS.

Document-exchange application 500 may send messages in message area 540from the user to web portal 240. Web portal 240 may then send themessage to the recipient through message sender 260 according to aprotocol. Document-exchange application 500 may also receive messagesfrom web portal 240. Document-exchange application 500 may receivemessages from web portal 240 and display them in message area 540.

Recipient field 510 may allow a user to specify recipients for aparticular message. Recipient field 520 may allow a user to specifymultiple recipient addresses separated by a delimiter, or recipientfield 520 may reflect recipient addresses the user selected from a list,as described below in reference to address book 515.

Recipient field 510 may interact with address book 515, such as allow auser to select from a list of recipients. Address book 515 mayautomatically fill out recipient field 510 on behalf of the user. A usermight only be permitted to enter recipients into recipient field 510using address book 515.

Address book 515 may contain a list of recipients, which may includethose in the same organization as the user. For example, address book515 may contain a list of employees at the hospital at which a doctorworks, and the list may include employees provided by the hospitalrepresentative after document-exchange system 201 provisioned asub-domain to the hospital. The list may include those in the hospitalthat have been provisioned user addresses. Address book 515 may alsoprovide a list of recipients with all users and organizations that haveregistered with document-exchange system 201. For example, the list mayinclude a state-wide or nation-wide list of users that have registeredwith document-exchange system 201.

Address book 515 may allow users to search for recipient addresses, orto select the organization to which the recipient belongs to and onlyshow addresses from that organization using data, such as organizationalstructure 300. Address book 515 may allow users to filter addresses bycategory in an organization, such as by department or occupation, andmay allow users to search or filter for recipients based on additionalor alternate criteria. Address book 515 may also allow users to show allusers or organizations that comply with a particular protocol or showall protocols a particular user or organization complies with.

Address book 515 may provide an interface to allow a user to filter orsod potential recipients, for example based on proximity, geography,location in an organizational structure, protocols, addresses, securitystrength, or date. For example, address book 515 may provide aninterface to allow users to search for user addresses in a five-mileradius, or may allow users to select from other users or organizationsin an umbrella organization or association, such as a HISP, HIE, orhospital chain. Address book 515 may also allow users to filter the listof potential recipients to show only those that comply with a certainprotocol, such as the Direct standard. Address book 515 may allow usersto filter the list of potential recipients based on a region or presencein a Health Service Area (HSA) or Health Referral Region (HRR). Addressbook 515 may also display a list that includes indicators forcategories, or a list of all addresses and with colored tags to indicatethe protocols each address complies with. Address book 515 may alsodisplay a list of addresses and highlight those that are part of thedocument-exchange system.

Address book 515 may also include recipients not registered withdocument-exchange system 201, or previously used recipients. Also,address book 515 may provide a list of recipients registered withanother document-exchange system, which may occur if the provider ofdocument-exchange system 201 partners with a another document-exchangesystem provider and exchanges a list of user addresses.Document-exchange system 201 may then store the list of user addressesfrom the second document-exchange provider in database 220 and transmitthat list to document-exchange application 500 to be displayed inaddress book 515.

Alternatively, address book 515 may provide a list of recipients from athird-party directory, such as those from an electronics health record(EHR) vendor, HISP provider directory, or a national database authority.

From field 520 may allow a user to specify a user address or one of manyuser addresses from which the user is authorized to send messages. Adoctor at a hospital may be authorized to send messages through anindividual doctor's user address as well as through another user ororganizational address due to his role as a hospital administrator. Fromfield 520 may also allow a user to specify back-end addresses to use.For example, from field 520 may include a button (not shown) that allowsa user to select from a list of back-end addresses associated with auser address, where each of these back-end addresses may be associatedwith a particular protocol.

On the other hand, from field 520 may prevent the user from selectingfrom a list of back-end addresses. For example, from field may onlyallow the user to select a protocol according to which the message is tobe sent. In such a case, from field 520 may not allow the user to selectthe back-end address and handles the selection transparently.

Field 520 may provide a button (not shown) that allows a user to selectfrom a list of protocols, such as a list of protocols for which the userhas back-end addresses. Field 520 may allow a user to select form a listof protocols with which the user's address complies. The list ofprotocols provided by from field 520 may depend on one or more factors,such as the desired recipient, the location of the recipient, therecipient's protocol capabilities, or the location of the user/sender.The list of protocols in from field 520 may also depend on a region, ormay depend on the HSA or HRR where the user or organization is located.

Message area 540 allows the user to enter information to be sent in amessage. Message area 540 could be a blank space into which a user mayenter textual information to be sent as a message. Message area 540 maybe a text box incorporating word-processing features (such ashighlighting, fonts, styles, tables, etc.) that assist the user incomposing a document or a blank space where a user may enter non-textualinformation, such as pictures, video, multimedia flies, or documentimages.

Message area 540 may include message fields 550, 560, 570, and 580 inFIG. 5. As used in this disclosure, a “message field” refers topredefined content, such as predefined text information or graphicalinformation like a textual or graphical header indicating the date orsource of the message. In FIG. 5, message field 550 includes the text“Name:” as predefined text information.

A message field may also include user input fields, which areuser-interface elements that allow users to enter information. Forexample, message field 550 includes a user-input field in the form of atext box that allows the user to enter a name associated with themessage. User-input fields may allow users to enter a variety ofinformation, such as textual information if the user input field is atext box or text area with word processing features. User input fieldsmay also allow users to enter non-textual information, such as pictures,videos, document images, sound files, other multimedia files, x-rays, or3D scans like a CAT scan.

If message area 540 does not include message fields, it can allow a userto compose a message from scratch. Message area 540 may include defaultmessage fields that might correspond to an organization, such as anorganization header, or to an organization's policy. The message fieldsmay be stored in database 220. Document-exchange application 500 maycommunicate with document-exchange system 201 and database 220 todetermine which message fields to include in area 540.

Template selector 530 may allow users to select a message template. Itcould be a button. In FIG. 5, template selector 530 is a button thatdisplays a list or other representation of available message templates.

A message template may be a predefined message with predefined fields.Message area 540 includes a message template with message fields 550,560, 570, and 580. Message templates may contain message fields specificto business processes or workflows. These templates might correspond toworkflows common in a hospital setting, such as requesting a record,ordering of a test, submitting documents for an audit, sending recordsto a patient portal, or referring a patient to another provider forcare. Message templates may include message fields appropriate for theparticular template. For example, a message template for requesting arecord may include fields for the type of record, record identificationnumber, patient name, request-by date, and/or other information relevantto a record request. A message template for a patient referral mayinclude message fields for the patient name, the referringorganization's name, a date, or other fields appropriate for a patientreferral.

A message template may include both mandatory and optional fields. Forexample, a message template corresponding to a reply to a recordsrequest may include a mandatory text field for the patient name and amandatory document attachment field for the patient record. The messagetemplate may also include an optional text field for organization orphysician notes.

Database 220 may store message templates and communicate them todocument-exchange application 500 through web portal 240. Database 220may also store all of the message templates available to a particularorganization based on that organization's subscription todocument-exchange system 201, and communicate those templates todocument-exchange application 500 for selection by template selector530. Database 220 may also store the message templates the provider ofdocument-exchange system 201 defines.

Database 220 may also store message templates a particular protocoldefines. For example, a national standards-setting organization orgovernment may mandate a particular format or syntax, or require certaininformation in a particular message type. The government may mandatethat every records request include a social-security number, so themessage templates for record requests may include a mandatory messagefield for a social-security number.

Document-exchange system 201 may also allow organizations to definetheir own custom message templates. For example, web portal 240 mayprovide an interface for an organization representative to definemessage templates to store in database 220.

Template selector 530 may select a message template based on thespecific business process or workflow of the user. The selection can bemanual from a list of templates, and template selector 530 may even helpa user select the message template by providing a list offrequently-used templates.

Template selector 530 may select message templates automatically, forexample, based on the type of message received. For example, templateselector 530 may automatically select a patient-record template whenreplying to a patient records-request message. Template selector 530 mayalso automatically select the message template based on the user orlocation of the user in the organization. For example, template selector530 may select the message template for patient referrals for a user inthe referral department or when document-exchange application 500 isrunning from a device in the referral department. Such information maybe obtained from database 220, which may store organization structure300, or may automatically select the template corresponding to CAT scanswhen document-exchange application 500 is running on a device near theCAT scan machine. Template selector 530 may also help a user select atemplate or automatically select a template in other ways, such as pasttemplate selections or recently viewed messages.

Template selector 530 may also pre-fill one or more of the messagefields based, for example, on the message replied to. For example, as aresult of replying to a records request message for patient “Cindy Doe,”template selector 530 may select the message template for patientrecords and pre-fill the message field corresponding to the patient namewith “Cindy Doe.”

Template selector 530 may also pre-fill message fields based on abusiness specific workflow, for example, one that sends a patient recordafter a patient referral. In this example, template selector 530 mayautomatically select a message template for sending a patient recordafter the document-exchange application sends a patient referralmessage, and may pre-fill message fields common to the patient-recordand patient-referral templates.

Template selector 530 may also pre-fill user input fields. For example,template selector 530 may pre-fill a user input field corresponding tothe patient's name, based on a received message being replied to with“Ben Doe.” The user may then edit the name, for example, to “BenjaminDoe.” Template selector 530 may also pre-fill message fields that do notallow user edits.

FIG. 6 illustrates an exemplary system for implementing embodimentsconsistent with this invention. As shown in FIG. 6, exemplary system 600may include a processor 610 (also referred to as an electronicprocessor, central processing unit, or CPU) for managing and processingdata, and performing operations consistent with this disclosure.Processor 610 may actually be one or more processors. System 600 mayeven be a special-purpose machine designed and configured to implementsome or all of the components in FIG. 2. System 600 also includes RAM620, ROM 630, and database 640. Database 640 may comprise optical,magnetic, signal, and/or any other type of storage device. System 600may also include communication interface 670 that may comprise a networkadaptor and may allow system 600 to connect to electronic networks, suchas the internet, a local area network, a wide area network, a cellularnetwork, a wireless network, or any other type of network.

System 600 may include input device 650, which receives input from usersor devices, such as keyboards, mice, trackballs, trackpads, eye-trackingdevices, scanners, input or touch-sensitive screens, and cameras. System600 also includes output device 660, which transmits data to users ordevices, such as computer monitors, televisions, screens, projectors,printers, and plotters.

System 600 may implement some or all of the components in FIG. 2, suchas features of document-exchange system 201 and some or all of thefeatures in FIG. 5. For example, system 600 may execute instructions todisplay the GUI of document-exchange application 500 on output device660, and receive user input through input device 650.

Other embodiments of the invention will be apparent to those skilled inthe art from consideration of the specification and practice of theinvention disclosed herein. The specification and examples are onlyexemplary, with the true scope and spirit of the invention beingindicated by the following claims.

What is claimed is:
 1. A cloud-based computer-implemented method forexchanging messages between users over a network, the method comprisingthe following operations performed by a processor: receiving aregistration request from an organization having a first user;provisioning an organizational sub-domain based on the Doman NameSystem, the sub-domain being a child domain under a parent domaincorresponding to the organization; verifying the registration requestaccording to requirements of a first protocol; provisioning a first useraddress to the first user wherein the user address is part of theorganizational sub-domain; and sending a message from the first useraddress to a second user address according to the first protocol.
 2. Themethod of claim 1, further comprising: selecting the first protocolbased on a location of the first user in the organization.
 3. The methodof claim 1, further comprising verifying the identity of the first user.4. The method of claim 1, further comprising providing a list ofprotocols for sending the message.
 5. The method of claim 4, wherein theprotocols in the list of protocols reflect at least one of: a locationof the organization; a region; a location of the first user; and alocation of the second user.
 6. The method of claim 1, furthercomprising: determining a type of transaction associated with themessage; formatting the message based on the type of transaction;providing a message field to the first user based on the type oftransaction; selecting the first protocol for sending the message basedon the type of transaction; and sending the message using the firstprotocol.
 7. The method of claim 6, further comprising: filling themessage fields based on a second transaction associated with themessage.
 8. A system for exchanging messages between users over anetwork, the system comprising: a storage device configured to storeinstructions; a processor configured to execute the followinginstructions: receive a registration request from an organization havinga first user; provision an organizational sub-domain based on the DomainName System, the sub-domain being a child domain under a parent domaincorresponding to the organization; verify the registration requestaccording to requirements of a first protocol; provision a first useraddress to the first user wherein the user address is part of theorganizational sub-domain; and send a message from the first useraddress to a second user address according to the first protocol.
 9. Thesystem of claim 8, wherein the instructions are further configured tocause the processor to: select the first protocol from among at least asecond protocol and a third protocol based on a location of the firstuser in the organization.
 10. The system of claim 8, wherein theinstructions are further configured to cause the processor to: provide alist of protocols for sending the message.
 11. The system of claim 10,wherein the contents of the list of protocols reflect at least one of: alocation of the organization; a region; a location of the first user;and a location of the second user.
 12. The system of claim 8, whereinthe instructions are further configured to cause the processor to:determine a type of transaction associated with the message; format themessage based on the type of transaction; provide one or more messagefields to the first user based on the type of transaction, the messagefields comprising required fields and/or optional fields; select thefirst protocol for sending the message based on the type of transaction;and send the message using the first protocol after the required fieldsare filled out.
 13. The system of claim 12, wherein the instructions arefurther configured to cause the processor to: pre-fill one or more ofthe message fields based on a second transaction associated with themessage.
 14. A non-transitory computer-readable medium storinginstructions, the instructions configured to cause a processor toperform operations comprising: receiving a registration request from anorganization having a first user; provisioning an organizationalsub-domain based on the Domain Name System, the sub-domain being a childdomain under a parent domain corresponding to the organization;verifying the registration request according to requirements of a firstprotocol; provisioning a first user address to the first user whereinthe user address is part of the organizational sub-domain; and sending amessage from the first user address to a second user address accordingto the first protocol.
 15. The computer-readable medium of claim 14,wherein the instructions are configured to cause the processor toperform operations further comprising: selecting the first protocol fromamong at least a second protocol and a third protocol based on alocation of the first user in the organization.
 16. Thecomputer-readable medium of claim 15, wherein the instructions areconfigured to cause the processor to perform operations furthercomprising providing a list of protocols for sending the message. 17.The computer-readable medium of claim 16, wherein the contents of thelist of protocols reflect at least one of: a location of theorganization; a region; a location of the first user; and a location ofthe second user.
 18. The computer-readable medium of claim 15, whereinthe instructions are configured to cause the processor to performoperations further comprising: determining a type of transactionassociated with the message; formatting the message based on the type oftransaction; providing one or more message fields to the first userbased on the type of transaction, the message fields comprising requiredfields and/or optional fields; selecting the first protocol for sendingthe message based on the type of transaction; and sending the messageusing the first protocol after the required fields are filled out. 19.The computer-readable medium of claim 18, wherein the instructions areconfigured to cause the processor to perform operations furthercomprising pre-filling one or more of the message fields based on asecond transaction associated with the message.